Manager, Medicaid Managed Care Quality Review

Alliant Health Group is a family of companies that provides professional services supporting the effective administration of healthcare programs and funding to support healthcare improvement initiatives. Alliant Health Solutions provides Federal and state government entities with the services, expertise and information systems necessary to increase the effectiveness, accessibility and value of health care.

Currently, Alliant Health Solutions, a "2024 Best Place to Work and Healthiest Employer", seeks a Medicaid Managed Care External Quality Review Secret Shopper Manager. This role is contingent upon award of contract. The Medicaid Managed Care External Quality Review Secret Shopper Manager will oversee the implementation and execution of secret shopper programs as part of an independent External Quality Review program to validate Medicaid managed care plan performance measures required in state contracts . This role involves designing assessment methodologies, analyzing data, and ensuring compliance with state and federal regulations.

In this role, the ideal candidate will:

• Develop and manage the secret shopper program to assess the performance of Medicaid managed care organizations for compliance with state contract requirements and performance metrics.
• Create and implement evaluation criteria and methodologies for validation assessments.
• Recruit, train, and supervise secret shopper staff to ensure effective data collection and reporting.
• Monitors field staff activities, including work assignments and call/visit productivity metrics.
• Implements and manages Interrater Reliability (IRR) program for secret shopper phone calls and onsite visits.
• Collaborate with internal teams to analyze findings and develop actionable insights.
• Prepare comprehensive reports on validation assessments, highlighting trends and areas for improvement.
• Ensure adherence to state and federal regulations regarding quality assurance and managed care practices.
• Liaise with Medicaid managed care organizations to communicate findings and recommendations.
• Conduct regular audits and reviews to maintain program integrity and effectiveness.
• Stay updated on industry trends, best practices, and regulatory changes affecting managed care quality evaluation.

• Work in close collaboration with other team members to support the development of new projects and the continuous improvement of the overall work of the team.
• Promote core values of teamwork, professionalism, effective communication skills and positive behaviors.
• Maintain security and confidentiality of all information in accordance with HIPAA laws and regulations and company policies.
• Demonstrate compliance with company and departmental policies as evidenced by attendance, punctuality, and dress.
• Perform other duties as assigned.

• Computer literate
• Ability to travel by car or plane to Company locations, customer meetings or other locations as needed.
• Strong understanding of Medicaid managed care regulations and quality metrics
• Excellent analytical and problem-solving skills
• Proven experience in project management and team leadership
• Strong communication and interpersonal skills
• Proficient in data analysis tools and software

• Bachelor's degree in public health, health administration, or a related field
• 5+ years of experience in managed care, quality assurance, or healthcare analysis

Alliant offers work/life balance and great benefits including medical, dental life, disability, paid-time off, retirement with match and contribution, disability, employee assistance program, parental life, and more. If interested, click the apply icon above to apply. If you are limited in the ability to access or use this online application process and need an alternative method for applying, we will determine an alternative method for you to apply. Please contact 678-527-3000.